Health care reform issues go beyond mandate

The individual mandate won’t be the only star of the show at the U.S. Supreme Court’s oral arguments on the health law. It will share billing with three other major issues awaiting the justices’ review.

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The Obama administration says requiring most people to purchase health insurance (with income-related subsidies) falls directly under its constitutional powers to regulate commerce. To the administration, it’s all about free riders. People who don’t have insurance drive up costs for those who do, and everybody will need to access care at some point in their lives.

Opponents — 26 states and the National Federation of Independent Business — contend that if the Supreme Court accepts that argument, Congress would have free rein to order Americans to purchase anything. Broccoli. Vitamins. Detroit-made cars.

Being able to clearly define the limits of this principle will be “the whole case” for the administration, said Bradley Joondeph, a Santa Clara University law professor who follows the case at the ACA Litigation blog.

“How credibly can the government show that upholding this doesn’t mean that bailing out GM” next time would mean requiring individuals to purchase its cars, Joondeph said.

What if the mandate goes?

If the court decides the mandate is unconstitutional, it will have to figure out what happens to the rest of the health care law, which also contains insurance market and health care delivery system reforms as well as changes to Medicare and Medicaid.

If the mandate gets struck down, the Obama administration argues the law should stay on the books, with two key exceptions: the requirements that insurers cover everyone who applies; and that they use a “community rate” that ignores a person’s health status for underwriting. Without the mandate, these consumer-friendly provisions could drive up insurance costs because people could wait until they got sick to buy insurance, and there would be few healthy people in the risk pool to tamp down prices.

But opponents of the whole law think the law can’t stand without the mandate.

“Because the central part of the health care law is unconstitutional, we believe that the court should strike it down,” Senate Minority Leader Mitch McConnell and Carrie Severino, chief counsel of the Judicial Crisis Network, wrote in a recent POLITICO op-ed.

I think that health care reform is a great idea. I have type 1 diabetes and for me to get insurance, it was a nightmare until I found "Penny Health" search for them online and you can get affordable health insurance instantly.

Great, so therefore you must support universal healthcare (expansion of Medicare) or a public option. This HC bill was the compromise because (mostly) Republicans wouldn't support anything else that addressed the fact that the uninsured are making us pay for their emergency care (and poorer health for lack of affordable preventive care).

Or, you support letting HC providers to turn away uninsured emergency room victims. "Sorry, go find a church or something".

This law was not put forth to appease the Republicans and not one voted for it.

The uninsured are a problem but this law does nothing to solve that problem, as it subsidizes large numbers of people with tax dollars. How is that any different from what the current system (mess) forces us to do, subsidize those who can't/won't take care of themselves?

Last month Obama's acting budget director, Jeffrey Zients, testified before Congress that the penalty imposed on those who do not purchase health insurance does not constitute a tax.

So...this is the rule and how Medicare Part D is intrepeted/implemented...........if a senior 65+ does not enroll in medicare part D within a prescribed enrollment period penalty will be imposed........right?

"That’s because of the esoteric Anti-Injunction Act, a strictly nonpartisan law that says that individuals can’t actually challenge a tax in court before they have to pay it."

pretty simple: obumbocare makes NO reference to the mandate being a tax (see also the Vinson decision), odumbo on the George Stephanopoulos (sp) ardently stated it was NOT a tax (didn't want to be seen raising taxes).

If it's NOT a tax, AIA does NOT apply. Possible problems: the Affordable Care Act is NOT affordable and the Patient Protection part does NOT protect patients.

I certainly hope they strike the bill down in its entirety and not leave us to suffer with it! Have you read it, or talked to someone who has? Your doctor, perhaps? It is a poorly crafted piece of legislation which escalates costs instead of lowering them as it claimed. That's because it doesn't address the cost drivers in medicine except to add insult to injury! Even before the full implementation of Obamacare, doctors are retiring and fleeing in droves. Bad for patients. Some smaller hospitals are closing. Bad for patients. Employers can't afford the more expensive insurance required under Obamacare and aren't expanding if not shrinking, bad for jobs and patients. Insurance companies are raising premiums because of Obamacare's expensive requirements: bad for patients. Bad for jobs if those companies fold. Even the public option isn't attractive: I've been on public and private and there is NO comparison in quality of care. Bad for patients. And of course, the costs will be astronomically higher than projected like every other government program, which taxpayers get to cover. Bad for everyone!

The current law also says that come August 1 now, 2012, Medicare will no longer reimburse individuals involved in care, but give out a certain amount based solely upon diagnosis. This amount of money would not change based upon severity of the disease, length of stay, extra testing, etc. That means all doctors (and the hospital) will have to divide up the money in some way hopefully reflective of care given, and the result is projected to halve doctors' pay to a little over $100k. This might not be a big deal were medical education so long and expensive and malpractice so high. But Obamacare lacks any tort reform, so medical costs will continue to be high so that doctors can assure lawyers in court that they did everything possible to care for their patients, including unnecessary expensive tests and labs. Not that I blame them for not wanting to get their butts sued off. I blame Obamacare for leaving out changes to the biggest cost driver in medicine, but what do you expect from a bunch of lawyers?